Doctor Name: | JEAN WEDNER ROUSSEAU |
NPI Number: | 1750485900 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 06203R |
Business Practice Address: | 4140 Hollywood Avenue Shreveport, LA - 711097818 |
Business Phone Number: | 3186219600 |
Business Fax Number: | 3186210169 |
Mailing Address: | 4140 Hollywood Avenue, SHREVEPORT |
State: | LA |
Postal Code: | 711097818 |
Phone Number: | 3186219600 |
Fax Number: | 3186210169 |
NPI Enumeration Date: | 09/09/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 06203R |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |